A Study by the National Association of Urban Hospitals September 2012
|
|
- Carmella Johnston
- 8 years ago
- Views:
Transcription
1 The Potential Impact of the Affordable Care Act on Urban Safety-Net Hospitals A Study by the National Association of Urban Hospitals September 2012
2 Introduction One by one and provision by provision, the federal government is implementing parts of the 2010 Affordable Care Act health care reform law that change how the government pays for health care services. In FY 2010, Medicare began reducing annual cost-of-living increases in hospital payments. In FY 2012, Medicare began making productivity adjustments to hospital payments. In FY 2013, Medicare will begin penalizing hospitals for readmitting large numbers of patients. In FY 2013, Medicare will introduce a value-based purchasing program that rewards some hospitals and penalizes others based on the outcomes of selected quality measures. More changes are coming soon, too. In FY 2014, Medicare will reduce by up to 75 percent the disproportionate share hospital payments (Medicare DSH) it makes to qualified hospitals. In FY 2014, Medicaid will introduce significant reductions in Medicaid DSH payments to qualified hospitals. Together, these new policies will result in significant reductions in government payments to urban safety-net hospitals. Urban safety-net hospitals are providers that are both private and non-profit; have at least 200 beds; are located in urban areas; provide at least 15 percent of their services to Medicaid patients; and are paid by the federal government under its Medicare inpatient prospective payment system. Today, 498 of the 3448 U.S. hospitals paid by Medicare under its inpatient prospective payment system 14.5 percent meet these criteria. Of these 498 urban safety-net hospitals, slightly more than half lost money in These hospitals, and many of the others that managed not to lose money, are already struggling financially and face further challenges in the near future because of additional changes in Medicare payment practices that will take effect on October 1, The following is a look at all of these changes and their current and projected impact on private urban safety-net hospitals. Cuts in Medicare DSH Payments The Affordable Care Act calls for reducing Medicare disproportionate share hospital payments, commonly referred to as Medicare DSH, by as much as 75 percent beginning in October of Medicare DSH payments are supplemental payments made to selected hospitals that care for especially large numbers of low-income patients. These hospitals suffer considerable financial losses caring for these patients, and the purpose of Medicare DSH payments is to help compensate them for those losses. 1 The Affordable Care Act calls for cutting Medicare DSH payments 75 percent in FY 2014 but will return some portion of that cut based on the documented care hospitals provide to uninsured patients (excluding non-legal residents). Thus, it is reasonable to assume that most, if not all hospitals, will receive some money back and therefore not sustain the full 75 percent cut. Because the federal government has never successfully collected uniform, reliable data on hospitals uncompensated care and, as of this writing, still has not decided how it will collect data for the purpose of restoring some Medicare DSH revenue to hospitals or how it will define uncompensated care, it is very difficult to estimate the degree to which the provision of uncompensated care will offset some of the 75 percent Medicare DSH cut. Potential Impact of ACA on Urban Safety-Net Hospitals September 2012 NATIONAL ASSOCIATION OF URBAN HOSPITALS 2
3 In FY 2014, the federal government s outlay for Medicare DSH is expected to decline by more than $9 billion; over five years, this cut will exceed $56 billion. Some of these reduced payments will be restored to hospitals based on how much uncompensated care they provide, but Medicare has not yet determined how it will define that uncompensated care, how it will collect uncompensated care, and what formula it will use to determine how much of the reduced Medicare DSH payments will be restored. Private, non-profit urban safety-net hospitals, just 14.5 percent of the acute-care hospitals covered by Medicare s inpatient prospective payment system, will absorb nearly half of that cut. The average private urban safety-net hospital will lose more than $8 million in Medicare DSH revenue in FY 2014 alone. Over five years, this will amount to a loss of more than $53 million in Medicare DSH revenue for the average private urban safety-net hospital. This is by far the largest and most damaging of all of the government payment changes mandated by the Affordable Care Act and will have an extremely damaging effect on the urban health care safety net. This plan to reduce Medicare DSH payments is predicated on the belief that health care reform will enable many more people to obtain health insurance, thereby relieving hospitals of much of their current responsibility for caring for patients for whom they are poorly paid or not paid at all. This assumption, however, does not adequately reflect four circumstances that all hospitals especially private urban safety-net hospitals will continue to face even after the full Affordable Care Act takes effect. Reform was expected to shift 15 to 20 million Americans into Medicaid, which in most states pays hospitals less than the cost of the care they provide. This creates a Medicaid shortfall the difference between what hospitals spend to care for their Medicaid patients and what their state Medicaid programs pay for that care. The expansion of Medicaid enrollment under the Affordable Care Act will increase hospitals Medicaid shortfalls, not decrease them. That figure of 15 to 20 million Americans moving into Medicaid is now in great doubt. In the wake of the Supreme Court decision that ruled unconstitutional the Affordable Care Act s mandate that states expand their Medicaid programs, the governors of several states have already declared their intention not to expand their Medicaid programs and some other governors are expected to follow suit after the November election. Thus, some uninsured people who were expected to enroll in Medicaid will undoubtedly remain uninsured. Approximately 23 million people were originally expected to remain uninsured despite reform, including 12 million undocumented residents, and hospitals will continue to serve them without reimbursement. These figures have long been considered optimistic, and now, with Medicaid unlikely to cover as many people as originally anticipated, the 23 million figure almost certainly is much too low. Hospitals that care for large numbers of low-income Medicare patients will be paid less than other hospitals because so many of those low-income Medicare beneficiaries cannot afford their Medicare co-pays and deductibles and do not pay them. Potential Impact of ACA on Urban Safety-Net Hospitals September 2012 NATIONAL ASSOCIATION OF URBAN HOSPITALS 3
4 All of these challenges are more likely to arise in the low-income communities that urban safety-net hospitals serve. Together, they raise important questions about the impact of the October 2013 Medicare DSH cut on hospitals. 2 The Medicare Hospital Readmissions Reduction Program Medicare launches a new Affordable Care Act-mandated hospital readmissions reduction program in October of This program penalizes hospitals when the rate at which they readmit Medicare patients within 30 days of discharge significantly exceeds that of other hospitals for patients who suffered from heart attacks, heart failure, and pneumonia. This program should cost hospitals about $300 million in FY 2014 alone. Of that amount, private urban safety-net hospitals, again just 14.5 percent of hospitals, are absorbing more than one-third of those revenue losses, as the following graph shows. Medicare s hospital readmissions reduction program poses a particular challenge for private urban safety-net hospitals. Many of the Medicare patients they serve are low-income individuals who have had only sporadic contact with the health care system throughout their lives, so they have numerous medical problems beyond those that resulted in their admission that sometimes require readmission to treat. In addition, these patients often lack a combination of the resources and access to supplemental community-based services needed to comply with their discharge instructions. According to a report by Harvard researchers presented to the American Heart Association in May of 2012, differences in regional hospital readmission rates are more closely tied to socioeconomic factors and access problems than they are to hospitals performance. An analysis by Kaiser Health News, a report in the Journal of the American Medical Association, and others echo these views and the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare payment policy, is now looking closely at this issue as well. Value-Based Purchasing Program Beginning in October of 2013, Medicare s new value-based purchasing program started rewarding or punishing hospitals based on their performance according to quality measures that hospitals report to the federal government. This program places urban safety-net hospitals at a decided disadvantage because it does not include sufficient risk adjustment for the additional medical challenges that the patients or urban safety-net hospitals often present. The result is that while urban safety-net hospitals collectively lose money under this program, all other acute-care hospitals gain additional revenue. 2 The Affordable Care Act will impose a major cut in Medicaid DSH payments as well beginning in FY 2014 but that cut is not addressed in this paper. These cuts will be based on states hitting certain federal triggers in their uninsured rates, but this approach makes it impossible to project the extent of these Medicaid DSH cuts on a hospital-by-hospital basis assuming individual states even hit those triggers. Potential Impact of ACA on Urban Safety-Net Hospitals September 2012 NATIONAL ASSOCIATION OF URBAN HOSPITALS 4
5 Another of the program s flaws is that it employs the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey of Medicare patients to evaluate hospital quality. Both the survey s questions and the manner in which they are weighted appear to be biased against large urban hospitals. In addition, studies have found that more seriously ill, lowincome patients are more likely to respond with negative observations when completing such surveys, and private urban safety-net hospitals care for such seriously ill patients in far greater numbers than other hospitals. Even Medicare s own data shows significantly lower survey scores in more urbanized areas. At the same time that hospitals struggle with all of these Affordable Care Act-mandated cuts, they also are dealing with a payment cut not related to the 2010 health reform law: a reduction in their Medicare bad debt reimbursement. Recognizing that low-income Medicare patients often cannot afford their co-pays and deductibles, Medicare has long reimbursed hospitals for the bad debt they incur when such patients fail to make those payments. Other Medicare Payment Cuts Reduced Cost-of-Living Adjustments and Productivity Adjustments Every year, Medicare adjusts hospital payments based on an index of health care costs. Beginning in FY 2010, Medicare began intentionally paying less than the annual cost-of-living increases indicated by that index. In FY 2013, its annual increase will be 0.1 percentage points less than the true rise in health care costs; in FY 2014, 0.3 percentage points less; in FY 2015 and FY 2016 it will be 0.2 percentage points less; and in FY 2017, FY 2018, and FY 2019 it will be 0.75 percentage points less. Medicare also believes hospitals are continually becoming more efficient in how they provide certain services, so in FY 2012 it began imposing productivity adjustments that decrease Medicare payments; those cuts will amount to 0.8 percentage points in FY Together, the market basket cuts and productivity adjustments will cost hospitals more than $1 billion in FY 2014 alone this is considered a conservative figure with private urban safety-net hospitals absorbing more than 36 percent of this cut. Reduced Medicare Bad Debt Reimbursement As of February of 2012, Medicare reduced its bad debt reimbursement from 70 to 65 percent. Based on hospitals FY 2009 Medicare cost reports, this will likely cost hospitals more than $115 million in FY 2014, and private urban safety-net hospitals, just 14.5 percent of those hospitals, will suffer nearly one-third of those losses, as the following chart shows. Sequestration Cuts Unless Congress intervenes, the Budget Control Act of 2011 will require $2 billion in Medicare payment cuts. As of this writing, Medicare has not indicated how it will make such cuts so it is impossible to calculate their potential impact on individual hospitals. Potential Impact of ACA on Urban Safety-Net Hospitals September 2012 NATIONAL ASSOCIATION OF URBAN HOSPITALS 5
6 Impact on Hospital Operating Margins As noted previously, of the 498 private urban safety-net hospitals in the U.S. today, more than onehalf lost money in A more in-depth means of evaluating hospitals financial performance is to look at their margins. Margins are ratios of hospitals expenses to their revenue, and the most telling is a hospital s operating margin, which includes only revenue derived from patient care and excludes non-patient care revenue from sources such as contributions, government appropriations, investments, parking, gift shops, and other sources that not all hospitals have. In 2009, the median operating margins of the country s 498 private urban safety-net hospitals and all other acute-care hospitals were virtually identical. Once the cuts mandated by the Affordable Care Act are all implemented, however, the balance of hospitals with positive and negative operating margins will shift significantly, as this chart shows. The anticipated reductions will turn 10 percent more urban safety-net hospitals into money-losing institutions and send their median operating margin plunging from percent to percent. Urban Safety-Net Hospitals That Lose Money Number Losing Money in FY2009 Number Losing Money After Cuts* 248 (50.2%) 297 (60.1%) *After 75% Medicare DSH, Bad Debt, Market Basket, Productivity, Value-Based Purchasing, and Readmissions Cuts (Estimated) Without question, the biggest influence on this dramatic fall in urban safety-net hospitals financial health will be the huge Medicare DSH cuts coming in FY Positive operating margins are important for all hospitals. If a hospital only covers its operating expenses that is, has an operating margin of 0.0 percent it will have difficulty finding cash to pay its bills and have no resources to fund needed capital investments such as new buildings and major facility maintenance and improvements. It also will find it difficult to purchase new equipment and technology, to service debt, and to invest in training and professional development for staff. The importance of a positive operating margin has given rise to the expression No margin, no mission. In general, hospitals are thought to need a positive operating margin of four percent to operate effectively. When a hospital has a negative operating margin, this means it is losing money, and just as businesses that consistently lose money go out of business, hospitals even nonprofit hospitals that cannot find a way to bring in more money than they spend eventually must reduce their services and accessibility and the staff that makes those services and accessibility possible. Potential Impact of ACA on Urban Safety-Net Hospitals September 2012 NATIONAL ASSOCIATION OF URBAN HOSPITALS 6
7 Conclusion Private, non-profit, mission-driven urban safety-net hospitals find themselves in a very difficult position today. Their already-precarious financial health is being subjected to the eroding effect of new Medicare payment policies mandated by the Affordable Care Act. The two biggest of those policies have yet to be implemented: the major reductions in Medicare DSH and Medicaid DSH payments that await these hospitals beginning in FY Both of these reductions will be especially harmful to urban safety-net hospitals. Together these losses of Medicare revenue especially the Medicare DSH cut threaten to turn some hospitals experiencing modest financial good health into money-losing institutions and to turn hospitals that already lose money into even bigger losers. It is conceivable that some of these losses will be so great that in the not-too-distant future, they will affect services, accessibility, and staffing at many urban safety-net hospitals. This, in turn, would create even bigger losers: the residents of the communities these hospitals serve. Those urban communities, which generally have especially large proportions of low-income and lowincome elderly residents, have come to rely on private urban safety-net hospitals as their primary provider of health care services and in some places, their only provider of such services. If, as the cuts required by the Affordable Care Act suggest, Medicare payments to hospitals are inadequate and some of those hospitals struggle financially, entire communities could feel their loss in a very tangible way. With the Medicare DSH, Medicaid DSH, and value-based purchasing cuts specifically and disproportionately targeting private urban safety-net hospitals, this appears very possible. Such circumstances suggest that it would be appropriate for policy-makers to reassess these cuts in light of the damage they might do and consider other possible means of achieving their desired ends. Methodology This study employed the Centers for Medicare & Medicaid Services (CMS) Medicare August 2012 Impact File and Medicare January 2012 Provider Specific Files to determine whether hospitals meet the criteria, outlined above, for designation as urban safety-net hospitals. This study derived hospital operating margins from FY 2009 Medicare cost reports (Hospital , Cost Report Data files, released August 13, 2012) that are filed by hospitals with CMS. This study estimated hospitals FY 2013 Medicare DSH payments by using the Medicare August 2012 Impact File and FY 2013 standardized amounts; the latter can be found in the final FY 2013 Medicare inpatient prospective payment system regulation, Federal Register, Vol. 77, August 31, 2012, pp This study inflated estimated hospital FY 2013 Medicare DSH payments for each year using the estimated market basket update, estimated productivity reductions, and market basket reductions described in section 3401 of the Patient Protection and Affordable Care Act of These estimates were multiplied by 75 percent the potential reduction in Medicare DSH payments established in the Affordable Care Act to yield the potential Medicare DSH cut in FYs when this cut will be implemented. This final calculation estimates the Medicare DSH reduction described in section 3133 of the Affordable Care Act but does not reflect the impact of the uncompensated care portion of the payment. Potential Impact of ACA on Urban Safety-Net Hospitals September 2012 NATIONAL ASSOCIATION OF URBAN HOSPITALS 7
8 The National Association of Urban Hospitals The National Association of Urban Hospitals advocates for adequate recognition and financing of private, non-profit, urban safety-net hospitals that serve America s needy urban communities. These urban safety-net hospitals differ from other hospitals in a number of key ways: they serve communities whose residents are much older and poorer; they are far more reliant on Medicare and Medicaid for revenue; they provide far more uncompensated care; and unlike public safety-net hospitals, they have no statutory entitlement to local or state funds to underwrite their costs. NAUH s role is to ensure that when federal officials make policy decisions, they understand the implications of those decisions for these distinctive urban safety-net hospitals. NAUH pursues its mission through a combination of vigorous, informed advocacy, data-driven positions, and an energetic membership with a clear stake in the outcome of public policy debates. For further information about the data presented and views expressed in this paper, please contact Ellen Kugler, Esq., NAUH s executive director, at ellen@nauh.org or Gentry Drive, Suite 210 Sterling, VA (703) (703) (fax) National Association of Urban Hospitals Potential Impact of ACA on Urban Safety-Net Hospitals September 2012 NATIONAL ASSOCIATION OF URBAN HOSPITALS 8
NAPH Summary of Proposed Medicare DSH Regulations
NAPH Summary of Proposed Medicare DSH Regulations On Friday, April 26, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule implementing the Medicare disproportionate share hospital
More informationEssential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013
Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Published: March 2015 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s
More informationAffordable Care Act at 3: Strengthening Medicare
Affordable Care Act at 3: Strengthening Medicare ISSUE BRIEF Fifth in a series May 22, 2013 Kyle Brown Senior Health Policy Analyst 789 Sherman St. Suite 300 Denver, CO 80203 www.cclponline.org 303-573-5669
More informationEssential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012
Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Published: July 2014 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s
More informationLinking Quality to Payment
Linking Quality to Payment Background Our nation s health care delivery system is undergoing a major transformation as reimbursement moves from a volume-based methodology to one based on value and quality.
More informationMedicare DSH: What is in the Proposed Rule and What it Means for Hospitals. May 23, 2013
Medicare DSH: What is in the Proposed Rule and What it Means for Hospitals May 23, 2013 1 Overview Pre-ACA Medicare DSH Program ACA Medicare DSH Reduction and Revised Methodology CMS Proposal Next Steps
More informationTHE MEDICAID PROGRAM AT A GLANCE. Health Insurance Coverage
on on medicaid and and the the uninsured March 2013 THE MEDICAID PROGRAM AT A GLANCE Medicaid, the nation s main public health insurance program for low-income people, covers over 62 million Americans,
More informationHospital Financing Overview
Texas Hospital Association 1108 Lavaca, Suite 700, Austin, TX, 78701-2180 www.tha.org Hospital Financing Overview Under federal law, hospitals are required to provide care to anyone who seeks it in their
More informationSNHPI Safety Net Hospitals for Pharmaceutical Access
SNHPI Safety Net Hospitals for Pharmaceutical Access Why the 340B Program Will Continue to be Important and Necessary after Health Care Reform is Fully Implemented Since 1992, the 340B drug discount program
More informationTHE GOVERNOR S FY 2015 BUDGET PROPOSAL FOR MASSHEALTH (MEDICAID) AND HEALTH REFORM PROGRAMS
THE GOVERNOR S BUDGET PROPOSAL FOR MASSHEALTH (MEDICAID) AND HEALTH REFORM PROGRAMS BUDGET BRIEF MARCH 2014 On January 22, the Governor released his budget proposal for the upcoming fiscal year (FY) 2015,
More informationCMS Readmission Penalties: Estimating the Impact of Socioeconomics and Race
CMS Readmission Penalties: Estimating the Impact of Socioeconomics and Race David Foster, PhD, MPH Truven Health Center for Healthcare Analytics September 2014 Highlights Adjusting for key socioeconomic
More informationThe Patient Protection & Affordable Care Act: Next Steps in Maine. February 8, 2013 1
The Patient Protection & Affordable Care Act: Next Steps in Maine February 8, 2013 1 Maine Medical Association Voluntary membership association of over 3,600 Maine physicians, residents, and medical students
More informationWalden University Q & A continued from Webinar Todd Linden
Walden University Q & A continued from Webinar Todd Linden General Note: The answers to these questions are my opinion. The mountain of rules and regulations that will be produced from this legislation
More informationFacilities contract with Medicare to furnish
Facilities contract with Medicare to furnish acute inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit
More informationSummary of Major Provisions in Final House Reform Package
SPECIAL BULLETIN Monday, March 22, 2010 This summary is five pages. Summary of Major Provisions in Final House Reform Package The U.S. House of Representatives late yesterday voted to pass landmark health
More informationThe American Tax Relief Act of 2012 Summary of Health Care Related Provisions January 2013
of 2012 Summary of Health Care Related Provisions On January 3, President Obama signed the American Tax Relief Act of 2012 (ATRA) to partially avert the so-called fiscal cliff, which would have resulted
More informationMEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
United States Government Accountability Office Report to Congressional Requesters June 2015 MEDICARE PART B DRUGS Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
More informationhow long can hospitals survive with negative margins?
AUGUST 2009 FEATURE STORY healthcare financial management Thomas M. Schuhmann how long can hospitals survive with negative margins? U.S. hospitals have for years offset negative margins on patient care
More informationJune 22, 2012. Dear Administrator Tavenner:
Submitted Electronically Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue
More informationThe meeting was called to order at 5:27 by the Chairman of the Executive Committee, Joseph Szot, M.D.
Minutes Carver College of Medicine Fall Faculty Forum: Health Care Reform Legislation - Its Implementation and Impact on UI Health Care Tuesday, October 26, 2010 Presenters: Vice-President Jean Robillard,
More informationPOLICY BRIEF. Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? October 2015. rhrc.umn.edu
POLICY BRIEF October 2015 Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? Peiyin Hung, MSPH Michelle Casey, MS Ira Moscovice, PhD Key Findings Over the first three years
More informationOverview of Policy Options to Sustain Medicare for the Future
Overview of Policy Options to Sustain Medicare for the Future Juliette Cubanski, Ph.D. Associate Director, Program on Medicare Policy Kaiser Family Foundation jcubanski@kff.org Medicare NewsGroup Journalism
More informationHAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE
HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE Cepheid s Government Affairs Department Advocating for Patient Access to Molecular Diagnostics in the Era of Healthcare Reform A TEAM APPROACH Legislative
More informationCode Blue: Many Kentucky Hospitals Struggling Financially Due to Health System Changes. April 2015
Code Blue: Many Kentucky Hospitals Struggling Financially Due to Health System Changes April 2015 Code Blue: Many Kentucky Hospitals Struggling Financially Due to Health System Changes Introduction Kentucky
More informationFiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)
Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Date 2015-04-17 Title Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and
More informationTHE FISCAL YEAR 2015 BUDGET FOR MASSHEALTH AND HEALTH REFORM PROGRAMS
THE FISCAL YEAR 2015 BUDGET FOR MASSHEALTH AND HEALTH REFORM PROGRAMS BUDGET BRIEF SEPTEMBER 2014 On July 10, 2014, Governor Deval Patrick signed the budget for fiscal year (FY) 2015, one week into the
More informationMinnesota Hospitals: Uncompensated Care, Community Benefits, and the Value of Tax Exemptions
Minnesota Hospitals: Uncompensated Care, Community Benefits, and the Value of Tax Exemptions Minnesota Department of Health January, 2007 Division of Health Policy Health Economics Program PO Box 64882
More informationPennsylvania s Medicaid program (Medical Assistance) has dozens of eligibility groups and programs, each with its own qualifying criteria.
1 Pennsylvania s Medicaid program (Medical Assistance) has dozens of eligibility groups and programs, each with its own qualifying criteria. Non Financial Factors include: Age; Disability (temporary, permanent
More informationissue brief Medicaid: A Key Source of Insurance in New Hampshire
issue brief April 20, 2011 Medicaid: A Key Source of Insurance in New Hampshire As state and federal policymakers come to grips with substantial budget shortfalls both now and into the future one public
More informationTexas Affordable Care Act Implementation: Challenges and Opportunities
Texas Affordable Care Act Implementation: Challenges and Opportunities Texas Robert Greenwald Clinical Professor of Law Director, Center for Health Law and Policy Innovation of Harvard Law School January
More informationAiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program
Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program Cristina Boccuti and Giselle Casillas For Medicare patients, hospitalizations can be stressful; even more so when
More informationToday s Agenda. Statement of Conflicts of Interest 7/9/2015
Geri Brennan Assistant Director, Health Care United States Government Accountability Office Statement of Conflicts of Interest Geri Brennan has no actual or potential conflict of interest in relation to
More informationTeaching Hospitals: Their Impact on Patients and the Future Health Care Workforce
American Hospital association september 2009 TrendWatch Teaching Hospitals: Their Impact on Patients and the Future Health Care Workforce Teaching hospitals train future health care professionals, conduct
More informationThe Florida Legislature has a historical opportunity to extend health care coverage to
2425 TORREYA DRIVE TALLAHASSEE, FL 32303 PHONE: 850.385.7900 FAX: 850.385.9998 MARY ANNE DePETRILLO PRESIDENT WHITE PAPER: MEDICAID EXPANSION KENT R. SPUHLER DIRECTOR I. SUMMARY The Florida Legislature
More informationExpanded Health Insurance Coverage Options under the ACA
Page 1 Expanded Health Insurance Coverage Options under the ACA by Shanna Hanson, FHFMA Summary One of our industry s reform knowledge leaders overviews ways health care coverage is being expanded under
More informationAHLA. FF. Commercial Discounts and Charity Care: Reimbursement and Program Integrity Implications
AHLA FF. Commercial Discounts and Charity Care: Reimbursement and Program Integrity Implications Andrew D. Ruskin Morgan Lewis & Bockius LLP Washington, DC Institute on Medicare and Medicaid Payment Issues
More informationEfforts by CMS and Medicaid Services in 2014
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 May 21, 2015 Justin Senior Deputy Secretary for
More informationHOSPITAL VALUE- BASED PURCHASING. Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of- Care Trends
United States Government Accountability Office Report to Congressional Committees October 2015 HOSPITAL VALUE- BASED PURCHASING Initial Results Show Modest Effects on Medicare Payments and No Apparent
More informationThe Affordable Care Act and North Carolina
The Affordable Care Act and North Carolina Christopher J. Conover, PhD Center for Health Policy and Inequalities Research Duke University March 12, 2014 Roadmap What is in the ACA as it relates to healthcare/
More informationWestchester Medical Center. 2015 Operating Budget
Westchester Medical Center 2015 Operating Budget December 3, 2014 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2015 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue
More informationHow To Improve Health Care For All
TIMELINE FOR IMPLEMENTATION OF THE AFFORDABLE CARE ACT 2010: NEW CONSUMER PROTECTIONS Eliminated pre-existing coverage exclusions for children: under age 19. Prohibited insurers from dropping coverage:
More informationUnfulfilled Expectations: An analysis of charity care provided by 340B hospitals
Unfulfilled Expectations: An analysis of charity care provided by 340B hospitals A publication of the Alliance for Integrity and Reform of 340B (AIR 340B). Avalere Health performed supporting research
More informationHealthcare Reform (ACA) Update Greater Magnolia Chamber of Commerce
Healthcare Reform (ACA) Update Greater Magnolia Chamber of Commerce FREDDY WARNER System Executive, Public Policy & Government Relations Memorial Hermann Health System March 27, 2014 PRESENTATION OUTLINE
More informationTimeline: Key Feature Implementations of the Affordable Care Act
Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next
More informationDifferential Charging to Medicare and Self-Pay and Commercial Customers by
Differential Charging to Medicare and Self-Pay and Commercial Customers by Andrew Ruskin Morgan Lewis I. Recent Developments A. Bitter Pill, Time Magazine (March, 2013) 1. Allegations throughout that the
More informationPolicy Analysis Brief. How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
Policy Analysis Brief July 2007 W Series No. 11 How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals? Janet P. Sutton, Ph.D., Alene Kennedy, B.A., Lucia Hammer, MPA and Grace
More informationFast Facts. Hospitals Participation In the Texas Medicaid Program
2012-2013 Fast Facts Hospitals Participation In the Texas Medicaid Program Texas Hospital Association Medicaid: Health Coverage Program Primarily for Children, Pregnant Women, Disabled and Elderly 2012
More informationKansas Health Policy Forums
Forum Brief 2004 Kansas Health Policy Forums The Medicare Reform Act: What Are the Consequences for Kansas? Thursday, March 18, 2004 Noon 2:30 Lunch provided 212 SW Eighth Avenue, Topeka, KS Lower Level
More informationInsure Tennessee. What is Insure Tennessee?
Coverage for Tennessee s uninsured that is market-based, promotes personal responsibility, addresses cost, and is a big step towards real healthcare reform in Tennessee. What is Insure Tennessee? 2 What
More informationThe Medicaid Consequences for Adults in 2014-2019
Net Effects of the Affordable Care Act on State Budgets Stan Dorn Matthew Buettgens The Urban Institute 2100 M. St. NW Washington, DC 20037 www.urban.org December 2010 Introduction and key findings The
More informationResults from the Commonwealth Fund s State Scorecard on Health System Performance Kansas in comparison to Iowa
Results from the Commonwealth Fund s State Scorecard on Health System Performance Kansas in comparison to Iowa Aiming Higher: Results from a State Scorecard on Health System Performance, published by the
More informationAd Hoc Advisory Committee on Freestanding ASCs and Charity Care. Draft Report
Ad Hoc Advisory Committee on Freestanding ASCs and Charity Care Draft Report Level of Service Paragraphs (2) and (3) of Subdivision (d) of 10 NYCRR section 709.5 require ambulatory surgery centers (ASCs),
More informationCommittee on Ways and Means Subcommittee on Health U.S. House of Representatives. Hearing on Examining Traditional Medicare s Benefit Design
Committee on Ways and Means Subcommittee on Health U.S. House of Representatives Hearing on Examining Traditional Medicare s Benefit Design February 26, 2013 Statement of Cori E. Uccello, MAAA, FSA, MPP
More informationFY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Proposed Rule
June 24, 2015 Andrew Slavitt Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Attention: CMS- 1629-P, Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850
More informationCOMPARISON OF THE FY 2015 HOUSE AND SENATE BUDGET PROPOSALS FOR MASSHEALTH AND HEALTH REFORM PROGRAMS
COMPARISON OF THE HOUSE AND SENATE BUDGET PROPOSALS FOR MASSHEALTH AND HEALTH REFORM PROGRAMS BUDGET BRIEF JUNE 2014 The Fiscal Year (FY) 2015 Massachusetts state budget has moved into the final stages
More informationCHAPTER 4 MEDICARE. Introduction. Supplementary Medical Insurance Part D
CHAPTER 4 MEDICARE Medicare by the Numbers (2007) Part A: Total Beneficiaries Elderly beneficiaries Disabled beneficiaries Total Income Hospital Insurance Part A Supplementary Medical Insurance Part B
More informationWhat is Healthcare Reform? Get a view of the future health care system in the US; learn. success factors for healthcare administrators?
What is Healthcare Reform? Get a view of the future health care system in the US; learn about primary resources and tools for the healthcare administrator, and what are the success factors for healthcare
More informationReimbursement Outlook and Analysis
HIDA Webinar Series Reimbursement Outlook and Analysis SNFs, HHAs, & IRFs Agenda Current Regulatory Landscape Skilled Nursing Facilities Home Health Agencies Independent Rehab Facilities Healthcare Reform
More informationRestructuring Medicare Cost Sharing: Options and Implications
Restructuring Medicare Cost Sharing: Options and Implications Alliance for Health Reform Washington, D.C. Juliette Cubanski, Ph.D. Associate Director, Program on Medicare Policy Kaiser Family Foundation
More informationThe GPO predominantly penalizes women educators in California, while the WEP penalizes many individuals who switch careers into public service.
Chair Pomeroy and Members, Social Security has met the social insurance promise to ensure workers will not have to live in old age poverty. This promise needs to be guaranteed for current and future workers.
More informationChanging Economics in an Era of Healthcare Reform
R E F O R M Changing Economics in an Era of Healthcare Reform Nathan S. Kaufman, Managing Director, Kaufman Strategic Advisors, LLC As health systems prepare for healthcare reform, they are focusing significant
More informationEligibility of Rural Hospitals for the 340B Drug Discount Program
Public Hospital Pharmacy Coalition www.phpcrx.org (A Coalition of the National Association of Public Hospitals and Health Systems) Eligibility of Rural Hospitals for the 340B Drug Discount Program Prepared
More informationMedicare Part D. MMA establishes a standard Part D drug benefit, which consists of four components or phases.
Medicare Part D The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added voluntary prescription drug coverage to Medicare, the federal health insurance program for seniors
More informationEXAMINING THE IMPACT OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT IN NORTH CAROLINA MEDICAID EXPANSION OPTION ISSUE BRIEF
EXAMINING THE IMPACT OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT IN NORTH CAROLINA MEDICAID EXPANSION OPTION ISSUE BRIEF As originally passed, the Patient Protection and Affordable Care Act (ACA)
More informationKey Features of the Affordable Care Act, By Year
Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll
More informationLIFT Perspective. Role of Government Series November 29, 2006. Reforming the Funding Mechanism of the Texas Health Insurance Risk Pool
LIFT Perspective Role of Government Series November 29, 2006 Reforming the Funding Mechanism of the Texas Health Insurance Risk Pool Recommendation The Texas Health Insurance Risk Pool plays an essential
More informationMarch 19, 2009. 820 First Street NE, Suite 510 Washington, DC 20002. Tel: 202-408-1080 Fax: 202-408-1056. center@cbpp.org www.cbpp.
820 First Street NE, Suite 510 Washington, DC 20002 Tel: 202-408-1080 Fax: 202-408-1056 center@cbpp.org www.cbpp.org March 19, 2009 HEALTH REFORM PACKAGE REPRESENTS HISTORIC CHANCE TO EXPAND COVERAGE,
More informationHealth Reform: The Cost of Failure and the Implications of Success
Health Reform: The Cost of Failure and the Implications of Success Bowen Garrett John Holahan June 17, 2010 National Association for Business Economics www.healthpolicycenter.org The Affordable Care Act
More informationMajor DSH Changes Under PPACA
Affordable Care Act Changes to Medicare DSH: Now That CMS s Proposal Is Here, What Does it Say? Dennis Barry Mark Polston Gregory Etzel 1 Major DSH Changes Under PPACA Section 3133 of the Patient Protection
More informationTESTIMONY OF JUDITH SOLOMON HOUSE BILL 700, THE PENNSYLVANIA HEALTH CARE REFORM ACT HOUSE INSURANCE COMMITTEE MAY 3, 2007
820 First Street NE Suite 510 Washington DC 20002 (202)408-1080 fax (202)408-1056 center@cbpp.org www.cbpp.org TESTIMONY OF JUDITH SOLOMON HOUSE BILL 700, THE PENNSYLVANIA HEALTH CARE REFORM ACT HOUSE
More informationJune 17, 2016. Dear Mr. Slavitt:
Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington, DC 20201 Re: CMS 1655 P, Medicare Program;
More informationCOMMUNITY HEALTH CENTER GROWTH AND SUSTAINABILITY STATE PROFILES VIRGINIA. Medicaid and Health Insurance Landscape 10
COMMUNITY HEALTH CENTER GROWTH AND STAINABILITY STATE PROFILES VIRGINIA CONTENTS Overview 2 CHC Scale 3 CHC Financial Status 5 Primary Care Need 8 Primary Care Transformation 9 Medicaid and Health Insurance
More informationWestchester Medical Center. 2014 Operating Budget
Westchester Medical Center 2014 Operating Budget December 4, 2013 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2014 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue
More informationImpact of Medicaid Expansion on Hospital Volumes
Impact of Medicaid Expansion on Hospital Volumes Executive Summary The Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of
More informationChanges in Health Insurance Coverage in the Great Recession, 2007-2010 John Holahan and Vicki Chen The Urban Institute Executive Summary
I S S U E P A P E R kaiser commission on medicaid and the uninsured Changes in Health Insurance Coverage in the Great Recession, 2007-2010 John Holahan and Vicki Chen The Urban Institute Executive Summary
More informationLatest House Republican Budget Threatens Medicare and Shreds the Safety Net
Latest House Republican Budget Threatens Medicare and Shreds the Safety Net Instead of Reducing Health Care Costs, Blueprint Shifts Costs to Seniors, Providers, Businesses, and States Topher Spiro March
More informationRefining the hospital readmissions reduction program
Refining the hospital readmissions reduction program C h a p t e r4 C H A P T E R 4 Refining the hospital readmissions reduction program Chapter summary In this chapter In 2008, the Commission reported
More informationPatient Protection and Affordable Care Act (H.R. 3590)
on Health Reform Passing comprehensive health care reform has been a priority of the President and Congress. The U.S. House of Representatives passed the Affordable Health Care for America Act on November
More informationThe Healthy Michigan Plan Baseline Reports on Uncompensated Care & Insurance Rates PA 107 105(d)(8-9) December 31, 2014
The Healthy Michigan Plan Baseline Reports on Uncompensated Care & Insurance Rates PA 107 105(d)(8-9) December 31, 2014 Submitted to The Michigan Department of Community Health and the Michigan Department
More informationImpact of Health Care Reform on. California Ambulance Association September 19, 2012
Impact of Health Care Reform on California s EMS System California Ambulance Association September 19, 2012 Impact of Health Care Reform on California s EMS System What is the Cost of Readiness? Patient
More informationMedicare Cost Sharing and Supplemental Coverage
Medicare Cost Sharing and Supplemental Coverage Topics to be Discussed Medicare costs to beneficiaries Review Medicare premiums and cost sharing Background on Medicare beneficiary income Current role of
More informationChapter 7 Acute Care Inpatient/Outpatient Hospital Services
Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services Executive Summary Description Acute care hospitals are the largest group of enrolled hospital providers. Kansas Medicaid has 144 acute care
More informationSupreme Court upholds the Affordable Care Act in its entirety:
Supreme Court upholds the Affordable Care Act in its entirety: What does this mean for Seniors? The Supreme Court s decision to uphold the Affordable Care Act (ACA) in its entirety is a huge victory for
More informationHow Will Hospital Readmission Penalties Impact Skilled Nursing Facilities?
How Will Hospital Readmission Penalties Impact Skilled Nursing Facilities? Patrick V. Trotta, CPA Director of ElderCare Provider Services Glass Jacobson patrick.trotta@glassjacobson.com 410 356 1000 Presentation
More informationThe Medicare Readmissions Reduction Program
The Medicare Readmissions Reduction Program Impact on Rural Hospitals Harvey Licht Varela Consulting Group August, 2013 CMS Readmissions Reduction Program: Authority Section 3025 of the Patient Protection
More informationHow To Compare The Health Care Reform Plan To The Health Insurance Reform Plan From The Health Plan Of A Medicare Plan
A Comparison of Medicare Proposals: The Affordable Care Act and the Romney/ October 2012 Prepared by: Area Agency on Aging 1-B A Comparison of Medicare Proposals: Affordable Care Act and the Romney/ Background
More informationWhat the Health Care Reform Bill Means to Employers
What the Health Care Reform Bill Means to Employers No doubt you have heard the news that on Tuesday, March 23, 2010, President Obama signed into law sweeping health care overhaul legislation. This followed
More informationThe Affordable Care Act: Is Healthcare Becoming More Affordable?
The Affordable Care Act: Is Healthcare Becoming More Affordable? Houston Economics Club Federal Reserve Bank of Dallas, Houston Branch November 17, 2014 Vivian Ho, PhD James A. Baker III Institute Chair
More informationIntroduction. What is Transparency in Health Care?
Introduction Transparency is a vital component of an efficient and effective health care system. As concerns about the cost and quality of health care in the United States continue to grow and large employers
More informationTHE FISCAL CONSEQUENCES OF THE AFFORDABLE CARE ACT
THE FISCAL CONSEQUENCES OF THE AFFORDABLE CARE ACT One of the motivating principles underlying passage of the Affordable Care Act (ACA) was that comprehensive health care reform would substantially improve
More informationMaryland Medicaid Program
Maryland Medicaid Program Maryland s Pharmacy Discount Waiver Tuesday, November 19, 2002 Debbie I. Chang Deputy Secretary for Health Care Financing Maryland Department of Health and Mental Hygiene Overview
More informationHOUSE OF REPRESENTATIVES
HOUSE OF REPRESENTATIVES HB 2010 2013-2014; health; welfare; budget reconciliation. Sponsor: Representative Pratt DPA X Caucus and COW House Engrossed OVERVIEW HB 2010 includes provisions to health and
More informationSeniors and the Affordable Care Act
Seniors and the Affordable Care Act Jon M. Bailey Director of Research and Analysis October 2013 Since the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010, we have conducted
More informationStatement of Dan L. Crippen Director Congressional Budget Office. on The Financial Status of Medicare
Statement of Dan L. Crippen Director Congressional Budget Office on The Financial Status of Medicare before the Committee on Finance United States Senate March 18, 1999 NOTICE This statement is not available
More informationThe Evolving Landscape of Payment Care Delivery and Manufacturer Implications of Coverage Expansion
November 2013 Edition Vol. 7, Issue 10 The Evolving Landscape of Payment Care Delivery and Manufacturer Implications of Coverage Expansion By Gordon Gochenauer, Director, Oncology Commercial Strategies,
More information340B program presents opportunities and challenges
NOVEMBER 2009 healthcare financial management MEDICARE/MEDICAID Christopher L. Keough Stephanie A. Webster 340B program presents opportunities and challenges AT A GLANCE > The 340B program provides an
More informationand the uninsured June 2005 Medicaid: An Overview of Spending on Mandatory vs. Optional Populations and Services
I S S U E kaiser commission on medicaid and the uninsured June 2005 P A P E R Medicaid: An Overview of Spending on vs. Optional Populations and Services Medicaid is a federal-state program that provides
More informationManaging Health Care Reform Benefit Changes within your Own Organization
ICCMHC Winter Conference February 17, 2011 Managing Health Care Reform Benefit Changes within your Own Organization John F. Gause, President jgause@apexbg.com Overview Health Care Reform - Short Term Impact
More informationThe Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending?
The Cost of Care for the : What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending? Issue Update 2004 Jack Hadley, Ph.D. and John Holahan, Ph.D. Prepared for the Kaiser Commission
More informationO N L I N E A P P E N D I X E S. Hospital inpatient and outpatient services
2A O N L I N E A P P E N D I X E S Hospital inpatient and outpatient services 2A-A O N L I N E A P P E N D I X Documentation and coding improvements What are documentation and coding improvements and how
More information